Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Township, MI
Last reviewed: May 2026
FHL tendonitis near Auburn Hills is consistently mislocated as “ankle pain” because the tendon runs behind the ankle — but it’s actually a big toe tendon problem, and the treatment protocol is completely different from standard ankle tendonitis. There’s also a specific big toe locking test that reveals whether the tendon has already developed a nodule. Call (810) 206-1402 — FHL tendon evaluations in Auburn Hills.
Medically Reviewed by: Dr. Tom Biernacki DPM · Board-Certified Podiatrist · Balance Foot & Ankle PLLC · Updated 2026
FHL Tendonitis Treatment Near Auburn Hills, MI
Flexor hallucis longus (FHL) tendonitis treatment near Auburn Hills, MI is available at Balance Foot & Ankle in Bloomfield Township. Dr. Biernacki DPM treats this “dancer’s tendon” injury — posterior ankle and inner heel pain from FHL inflammation — with orthotics, heel lifts, injection, and surgical release when needed. Call (810) 206-1402.
The FHL Tendon: Behind the Inner Ankle, Often Overlooked
The flexor hallucis longus (FHL) tendon runs from the calf through a fibro-osseous tunnel behind the medial ankle, beneath the sustentaculum tali, and inserts at the tip of the big toe. It powers push-off and great toe plantarflexion — critical for running and jumping sports. FHL tendonitis produces deep posteromedial ankle or inner heel pain that is routinely confused with PTTD, tarsal tunnel syndrome, or medial ankle sprain. The distinguishing feature: pain with resisted great toe flexion and possible triggering (catching/snapping) of the big toe during ankle range of motion. In our Auburn Hills-area patients, this injury is most common in runners with rapid training increases, dancers, and patients with an os trigonum (accessory bone) causing tendon impingement at the posterior ankle.
Key Takeaway: The key differentiator from PTTD: pain with resisted great toe flexion and possible big toe triggering. MRI confirms tendon integrity and identifies concurrent os trigonum. Ultrasound-guided injection is highly effective for acute FHL tendinopathy.
Treatment
Conservative treatment: Activity modification reducing push-off loading. Heel lift reduces FHL tension. Custom orthotics with arch support for overpronated feet. Ultrasound-guided corticosteroid injection around the FHL tendon sheath for acute tendinopathy. Surgical treatment: Arthroscopic or open FHL tendon sheath release through the fibro-osseous tunnel for cases failing conservative care. Concurrent os trigonum excision when present. Return to full activity in 3–4 months post-surgery.
⚠️ See a Podiatrist If:
- Deep posterior ankle or inner heel pain during push-off or running
- Pain when bending the big toe downward against resistance
- Big toe catching or snapping sensation during ankle motion
- Posterior ankle pain in a dancer or distance runner not resolving with rest
- Posterior ankle pain labeled “ankle sprain” that persists months later
Recommended Products for FHL Tendonitis Relief
Flexor hallucis longus tendonitis responds well to eccentric strengthening and offloading. Dr. Biernacki recommends these products for patients managing FHL tendon pain between appointments.
TheraBand Professional Resistance Bands
Resistance bands are essential for the eccentric toe-flexion exercises that rehabilitate the FHL tendon. TheraBand’s latex bands are the clinical standard — we use these in our own therapy protocols. Start with yellow (light) and progress to red as pain-free range improves. Use for towel-scrunching, toe curls, and ankle plantarflexion strengthening.
Tuli’s Heavy Duty Heel Cups
A small heel lift reduces tension through the posterior ankle and FHL tendon by limiting the degree of dorsiflexion at pushoff. Tuli’s waffle-cup design absorbs shock while gently elevating the heel 3/8 inch — enough to meaningfully offload the tendon without creating imbalance. Fits most athletic and dress shoes. Inexpensive and effective first-line intervention.
Getting to Our Office From Auburn Hills
Our Bloomfield Township office at 43494 Woodward Ave #208 is about 18 minutes from Auburn Hills via I-75 S to Woodward Ave. We accept most major insurance. Call (810) 206-1402 or book online.
Posterior Ankle Pain? Get the Right Diagnosis
Balance Foot & Ankle · Serving Auburn Hills & Michigan
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📋 Dr. Tom Biernacki, DPM, FACFAS answers:
FHL (flexor hallucis longus) tendonitis near Auburn Hills is inflammation of the tendon that runs behind the ankle and under the foot to control the big toe. It is particularly common in dancers, runners, and athletes who repeatedly push off on the toes. Our podiatrist serving Auburn Hills diagnoses this condition through clinical testing and MRI or ultrasound. Conservative treatment includes relative rest, ice, anti-inflammatory medications, calf stretching, and custom orthotics to reduce tendon strain. A walking boot may be prescribed for four to six weeks in more significant cases. Physical therapy with eccentric loading protocols strengthens the tendon and promotes healing. For chronic or nodular FHL tendonitis that does not respond to conservative care, minimally invasive surgical release of the tendon sheath may be performed. Patients near Auburn Hills typically return to full activity within two to four months.
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.
More questions patients ask
What is FHL tendonitis and how does it cause ankle and big toe pain?
The flexor hallucis longus (FHL) tendon runs behind the ankle through a fibrous tunnel and down to the big toe, controlling its downward push. FHL tendonitis causes pain behind the inner ankle, along the arch, or at the base of the big toe — often described as a deep aching that's worst with push-off. It's particularly common in ballet dancers, runners, and anyone who repeatedly plantarflexes the ankle under load. The tendon can also develop a nodule that catches in its tunnel, causing a 'trigger toe' — a locking or snapping sensation in the big toe.
How is FHL tendonitis treated?
Treatment begins with activity modification to reduce repetitive FHL loading, anti-inflammatory medications, and physical therapy targeting FHL eccentric strengthening and calf flexibility. A walking boot provides relief during acute flares. Custom orthotics can reduce tendon stress by optimizing big toe mechanics during the gait cycle. Corticosteroid injection is used cautiously near the FHL due to tendon rupture risk. Persistent cases — particularly those with a tendon nodule causing triggering — may require surgical tendon sheath release.
Can FHL tendonitis cause hallux rigidus or big toe arthritis?
Chronic FHL tendonitis doesn't directly cause big toe arthritis, but the two conditions often coexist and interact. Restricted FHL motion from inflammation or a nodule alters big toe joint mechanics during push-off, increasing stress on the first metatarsophalangeal joint over time. Conversely, hallux rigidus causes compensatory FHL overuse. A podiatrist evaluating persistent big toe pain evaluates both the FHL tendon and the first metatarsophalangeal joint to ensure the complete picture is treated.
Still have a question about coverage or cost? Book online and we will check your benefits before your visit: Book in Howell · Book in Bloomfield Township. Prefer to talk it through first? Call (810) 206-1402.